Randomised controlled trial of nurse continence advisor therapy compared with standard urogynaecology regimen for conservative incontinence treatment: efficacy, costs and two year follow up

Abstract

Objective To compare the efficacy and labour costs of nurse continence advisors and urogynaecologists in conservative management of urinary incontinence. Design Single centre randomised controlled trial of patients with mild or moderate leakage. Setting Tertiary urogynaecology unit. Sample One hundred and forty-five consecutive patients with stress and/or urge incontinence. Methods Standardised conservative therapy regimens, provided by nurse continence advisors and urogynaecologists. Main outcome measures One-hour pad test, frequency volume charts, a 20-point incontinence score and two quality of life tests, staff treatment times and costs. Results Of 110 women who completed 12-week treatments, 64% of the women in the nurse continence advisor group ( n = 58) and 52% of women treated by urogynaecologists ( n = 52) were asymptomatic (dry pad test; OR 1.63, 95% CI 0.71–3.75). There was no significant difference between clinician groups for change in pad test result ( P = 0.71), voids/day (0.43), incontinence score ( P = 0.57) or quality of life scores (urogenital distress inventory, P = 0.27; Incontinence Impact Questionnaire, P = 0.41). Despite the expected longer consultation times for the advisor group (median 160 min, interquartile range [IQR] 130–210) versus the urogynaecologist group (median 90 min, IQR 60–120), the per capita labour cost for advisor treatment (median AU$59.20, IQR 48.10–77.70) was lower than for treatment given by urogynaecologists (median cost AU$ 189.70, IQR 120.60–250.70, Mann–Whitney U test, P < 0.0001). At 2.5 years, 23/58 patients (40%) treated by advisor and 27/52 patients (52%) treated by urogynaecologist group, who had been cured and discharged, were available for contact. Of these, 29% of women in the nurse continence advisor group and 41% of those treated by urogynaecologists remained continent (on 20-point score). Quality of life improvement persisted equally in both groups. These data should be interpreted cautiously due to a 24% dropout rate. Conclusions The reduction in urine leakage and improvement in quality of life observed in patients treated by nurse continence advisors and urogynaecologists were similar at 12 weeks and 2 years, but lower costs arose from treatment provided by nurse advisors. We suggest that conservative treatment by the nurse continence advisor could be used more widely in mild to moderate incontinence.